A framework for considering health care reform

"The U.S. health care delivery system is ill," Paul Spaude, chief executive officer of Borgess Health, told a group of Kalamazoo Rotarians on Oct. 6.

His words were underscored on Oct. 11 when the Kalamazoo Gazette reported that, despite the fact that its revenue had grown 15 percent, Borgess Medical Center's income fell sharply in fiscal 2008 as more patients seeking treatment at the hospital were unable to pay their bills.

Borgess, which is part of Ascension Health, the nation's largest Catholic and nonprofit health system, experienced a drop of 88.5 percent in net income, from $13.1 million in 2007 to $1.5 million in 2008.

According to Rich Felbinger, chief financial officer at Borgess, some 63 percent of all acute-care hospitals in Michigan are losing money on operations this year.

"Every 60 seconds," Spaude said, "there is a new uninsured patient accessing one of our Ascension Health Care systems," which serves 20 states and the District of Columbia.
More than 1 million people in Michigan are uninsured.

Spaude spoke eloquently about the need for a health care system in America that works, is safe and leaves no one behind.

He made it abundantly clear that he is not advocating any political position.

What he does propose are some common-sense parameters to help provide a framework for considering any proposals to change the current system.

The principles he cited that would guide a plan for a reformed health care policy are:

• 100 percent coverage, with work to be done on what would be covered.

• Insurance benefit package equity;

• Attention to critical populations and coverage gaps;

• Insurance reforms creating larger pools of people;

• Economic viability in which all stakeholders share funding.

There is no single solution, he emphasized, since what works in southwestern Michigan might not be appropriate in New York City. But Spaude believes meaningful reform must occur at a federal level; and require a vast redesign that moves us away from small group plans.

"Insurance is a law of large numbers," Spaude pointed out. These small insurance pools are "crushing small business."

Here are the key questions he suggests anyone could ask as they consider health care reforms:

• Does the plan encourage redesigning the delivery system to improve health outcomes and achieve a one-tier system?

• Does the plan aim for 100-percent coverage for all?

• Is the proposed coverage adequate and affordable for all? Is the benefit package similar to what others in the community have?

• Does it address all vulnerable/safety-net populations? What is the impact on existing safety-net services to the vulnerable?

• Does the plan include adequate insurance reforms (e.g. is insurance available, affordable, and sustainable)?

• Is the plan funded in an adequate, sustainable fashion with the cost shared by multiple parties?

• Does the plan include a mechanism to require coverage?

Whether or not you agree with Ascension Health's core values, Spaude pointed out that the fact remains, the way it works today, we're all paying for the system -- and in the most expensive way -- at the crisis points, such as emergency rooms, where uninsured patients are driven to seek treatment.

Another issue that needs to be confronted is that we're spending way too much in the last six months of life. "Politicians won't say that," he said.

What Spaude is asking for is a commitment from all of us. Until we make that commitment, he said, there is no platform from which to work toward reform.

"Here's my call to action," he concluded, "what if we make a declaration that, by 2020, the U.S. must have a viable health care system that covers us?

"Wouldn't that be the greatest legacy to leave our children and grandchildren?"
He's got a good point.